Our Summary

This research paper compares two methods of removing an inflamed appendix in children: laparoscopic appendectomy (LA), a minimally invasive procedure, and open appendectomy (OA), a more traditional surgery. The study examined cases of complicated appendicitis, which means the appendix was severely inflamed, gangrenous, or had burst, or an abscess had formed around the appendix.

The researchers looked at studies conducted between 1997 and 2017. They analyzed six studies that randomly assigned patients to the two types of surgery, and 33 studies that allowed doctors to decide which procedure to use.

The results showed that children who had the laparoscopic procedure stayed in the hospital for less time and were less likely to get an infection at the surgical site than those who had the open procedure. The rates of abscess formation within the abdomen were similar for both procedures.

The laparoscopic procedure also had lower rates of readmission to the hospital, fewer instances of postoperative ileus or intestinal obstruction (a common complication after abdominal surgery where the intestine does not work properly), fewer instances of needing to operate again, and a shorter time before the child could eat normally. However, the open procedure was quicker to perform.

In the past, some research suggested that the laparoscopic procedure was linked to higher rates of abscess formation in the abdomen in cases of complicated appendicitis. But this study found no such link. Given the other benefits of the laparoscopic procedure, the researchers conclude that it should be the preferred method for treating complicated appendicitis in children.

FAQs

  1. What are the two methods of pediatric appendectomy compared in this research paper?
  2. How did the outcomes of laparoscopic appendectomy and open appendectomy compare in terms of hospital stay, infection rates, and other complications?
  3. What did the study conclude about the preferred method for treating complicated appendicitis in children?

Doctor’s Tip

A doctor might tell a patient that for pediatric appendectomy, the laparoscopic procedure is preferred over the open procedure for complicated appendicitis in children. This is because the laparoscopic procedure has been shown to result in shorter hospital stays, lower rates of surgical site infections, lower rates of readmission, fewer postoperative complications, and a quicker return to normal eating. It is important to discuss the best option for your child with your healthcare provider.

Suitable For

Pediatric patients who have complicated appendicitis, such as severe inflammation, gangrene, or a burst appendix, or the presence of an abscess around the appendix, are typically recommended for a pediatric appendectomy. In these cases, surgeons may opt for either a laparoscopic appendectomy or an open appendectomy.

Based on the findings of the research paper discussed above, children with complicated appendicitis who undergo a laparoscopic appendectomy may experience shorter hospital stays, lower rates of surgical site infections, fewer readmissions to the hospital, and quicker recovery times compared to those who undergo an open appendectomy. Despite concerns in the past about higher rates of abscess formation with laparoscopic procedures, this study did not find any significant differences in abscess rates between the two methods.

Therefore, pediatric patients with complicated appendicitis may benefit from choosing a laparoscopic appendectomy over an open procedure due to its overall advantages in terms of postoperative outcomes and recovery.

Timeline

Before pediatric appendectomy:

  1. Patient experiences abdominal pain, often starting around the belly button and moving to the lower right side of the abdomen.
  2. Patient may also have nausea, vomiting, fever, and loss of appetite.
  3. Patient undergoes physical examination and possibly imaging tests to diagnose appendicitis.
  4. Surgery is scheduled, and patient is prepped for the procedure.

After pediatric appendectomy:

  1. Patient undergoes either laparoscopic appendectomy or open appendectomy.
  2. Recovery time in the hospital is shorter for patients who had laparoscopic surgery.
  3. Patients who had laparoscopic surgery are less likely to get an infection at the surgical site.
  4. Patients who had open surgery may have a quicker procedure, but may have longer hospital stays and higher rates of postoperative complications.
  5. Patients who had laparoscopic surgery have lower rates of readmission, fewer instances of needing a second operation, and a shorter time before they can resume normal eating.
  6. The laparoscopic procedure is now considered the preferred method for treating complicated appendicitis in children.

What to Ask Your Doctor

  1. What are the benefits of a laparoscopic appendectomy compared to an open appendectomy for my child’s case of complicated appendicitis?
  2. How long will my child need to stay in the hospital after the surgery for each procedure?
  3. What are the risks and potential complications associated with both types of surgery?
  4. How soon after the surgery can my child resume normal activities and return to school?
  5. Will my child need any additional follow-up procedures or treatments after the surgery?
  6. What is the success rate of each type of surgery for treating complicated appendicitis in children?
  7. Are there any long-term effects or complications associated with either type of surgery that I should be aware of?
  8. How experienced is the surgical team in performing laparoscopic appendectomies for children with complicated appendicitis?
  9. How will pain management be handled for my child after the surgery, and what can I expect in terms of recovery and discomfort?
  10. Are there any specific dietary or activity restrictions my child should follow after the surgery, and for how long?

Reference

Authors: Low ZX, Bonney GK, So JBY, Loh DL, Ng JJ. Journal: Surg Endosc. 2019 Dec;33(12):4066-4077. doi: 10.1007/s00464-019-06709-x. Epub 2019 Feb 25. PMID: 30805783